Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2007 -00322
COMMUNITY DEVELOPMENT DATE ISSUED: 5/10/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 110 B B -00100
SITE ADDRESS: 14059 SW 119TH PL ZONING: R -4.5
SUBDIVISION: LOT : JURISDICTION: TIG
PROJECT: JUSTICE
Project Description: (3) Branch circuits for a/c and furnace outlets.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL /PANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 2 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
JUSTICE, JANICE T GRF ELECTRIC
14059 SW 119TH PL • 15460 S PARADISE LN
TIGARD, OR 97224 MULINO, OR 97042
Phone: Contact #: PRI 503 - 829 - 4146
FAX 503- 829 -5747
FEES
Description Date Amount Reg #: ELE 3 -484C
[ELPRMT] ELC Permit 5/10/2007 $60.15 LIC 76751
[TAX] 8% State Surcharge 5/10/2007 $4.81 SUP 1655S
Total $64.96 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All
work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for
more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
///
Issued By: - � . / Permittee Signature: ,�1 p)O '� Ca PM1
OWNER INSTALLATION ONLY (( r
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
May 10 07 10 :21a GRF Electric 5038295747 p.1
` FOR OFFICE USE ONLY
Eiee rica1 Permit p a lica ion : oactee/BVey 0 GLv Pe cal ��,(� t ~c0321
a ' #1 � V7
� ,.,•. -� �- Planning Approva Sign
City of Tigard Date/By: Permit No.:
•- 13125 SW Hall • Blvd. (� Plan Review Other
Tigard, Oregon 97223 P M 6 �-
'1' Y 1 V 2O� 2061-
Date/By: Permit l` p
Phone: 503 - 639 -4171 Fax: 503-59- 8 1960 Post- Review Land Use
�., . ).� !L °4+ °j� j Da te/By: Case No.:
Internet: www.ci.tigard.or.us ,^-" e tt �� .lu Contact ® See Page 2 for
24 -hour Inspection Request :E03=1'39-4 `5r-, : . 1 N Name/Method: r Supplemental Information.
'. PE OF'WORK °; `' sa::`:.:.: Pe'AN 7 REYIEW . (Pleise cfieck•ill:that ipPJY)
❑ New construction ❑ Demolition ❑ Service over 225 amps - ❑ Health -care facility
commercial ❑ Hazardous location
[<Addition/alteration / replacement ❑ Other: 0 Service over 320 amps rating of 0 Building aver 10,000 square feet,
' " ' : CATEGORY' OFiCONSTRUCTYON ,' "` '. : " I & 2 family dwellings four or more residential units in
& 2- Family dwelling ❑ Commercial/Industrial 0 System over 600 volts nominal one structure
0 Buildin g over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building • Multi- Family . ❑ Occupant load over 99 persons ❑ Manufactured structures or LW park
❑ Master Builder El Other: : ❑ Egress/lighti,tg plan ❑ Other:
,., .. Submit sets of plans with any of the above.
:LOB SITE' Ii1IFORMATI'ON and LOCATION' `. ; The above are not applicable to temporary construction service.
j• ( 1 i'1.
Job site address: ( '` S t.:: ( °:: ;;, , • ;'..
‘{ , : :• FEEt'�SCI3ElyttL ::
Suite #: ,Bldg. /Apt. #: Number of inspections per permit allowed
n..i:[iptiou I Qty Fee (ca.) r Total I
Project Name: l CI- t .- is New residential - single or multl- family per 1
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service Included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: ` L ot #: Limited energy, non residential 75.00 . 2
Tax reap /parcel #: Each manufactured home or modular dwelling
t . •• -- :.. "`.;, service and/or feeder 90.90 2
'D E$GRIPTION:OE:WORK i: :, ::. : ' :: ' . , .,. ,.
- ., •' <`���'�- : ' � � Services or feeders - installation,
2r 7 L L G r•' ••
•- -C__ e � / f K) t • _ , alteration or relocation: 80.30 2
S fit.
' r , 200 am_u or less
,s t � 201 amps to 400 amps 106.85 2
6::' 4't y t C ' 401 amps to 600 amps 160.60 2
illitri 6 01 amp to 1000 amps 240.60 2
. PRORERTTOWNER'`-.'' ..: ^: TEMAX!lT , . . = ,&.: ° .... or vote a54.65 2
Over 1000 amps
Name: c) 4 vi # r - ' ' ' c Z A i - 41' C { - Reconnect only 66.85 2
-
Address: ) '-f- pr. y'`7 L -;-' / 1 G'! p t , Temporary services or feeders - Installation,
alteration, or relocation:
City /State/Zip: 19 ,,9 = j Z Z. ¥ 200 amps or less 66.85 1
• f 201 amps to 400 amps
100.30 I 2
Phone: C Z] - 4- 4( Fax 401 to 600 amps 133.75 2
a; APPLiOANT :' ,, .!-� .:' , : ].CON }ACT'PERSON`:'y'" i Branch circuits - new, alteration, or
Name: , extension per panel:
_ A. Fee for branch circuits with purchase of 6.65 2
Address: _ service or feeder fee, each branch circuit
B. Fee for branch circuits without purchase of • S .,
- City/State/Zip: service or feeder fee, first branch circuit I. 46.85 / r,`' '. 2
I Fax: Eac additional branch circuit ? 6.65 ' t " •? - 2
Phone: --
E -mail: Misc.(Service or feeder not included): 2
;,,, Each pump or irrigation circle 53.40
:r': , t Tai,'' , ` f Z;.CUlalItd! ICTQR., . ` / Each sign or outline lightin& 53
Job No: Signal circuit(s) or a limited energy panel, 2
/� alteration, or extension Page 2
Business Name: G � 0 ce. --h-j r, . Description:
Address: -(f! C) s , P r[� ( i i � f ' 1 Each additional inspection over the allowable in of the above:
City /State /Zip: 114 /, e -.; (2 -. ' 2 (2 Per inspection per hour (min. t hour) 1 62.50
Phone: 9) 3 ' Q7 Li / `I (� Fax: 503 - 8 - 1 - 5 - 7 9 7 investigation fee: '-
B Lic. #: c Lc. #: 3 - . C. :';.Electi icai:PermltFees *`? '
CC `] � � 1 i ` `f _ .. , ,. . :.. ._ Subtotal $ t ,1 • ) t
Supervising electrician c 1 ( 'f'
signature required: '"'—'-'44-\1-'4 'r ' n r i 0 ` U - -I Plan Review (25% of Permit Fee) $ I. t o
Print Name: w,) ) i Ate,., < Lic. #: ZP SC $ State Surcharge (8% of Permit Fee) ,.
TOTAL PERMIT FEE , S 61 Z r
Authorized Notice: This permit application expires If a permit is not obtained within
Date: 180 days after lt.has been accepted as complete.
Signature: "Fee methodology set. by Tri- County Building Industry Service Board.
- (Please print name)
i :\Dsls\Pcrmit Forms\ElePermitApp.doc 01/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007-00322
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/10 /2007
Phone: (503) 639- 4171 -map "�
Inspection Requests (24 Hrs.): (503) 639 - 4175 :-!'I;
INSPECTION WORKSHEET FOR DATE: 5/17/2007 TIME: 7:00AM PAGE: 63
SITE ADDRESS: 14059 SW 119TH PL CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: JUSTICE
DESCRIPTION: (3) Branch circuits for a/c and furnace outlets.
OWNER: JUSTICE, ,,IANICE T, PHONE #:
CONTRACTOR: GRF ELECTRIC PHONE #: 503 -829 -4146
Inspection Request Scheduled For: Date: 5/17/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 048482-01 503 -567 -2220 Y / l
Corrections /Comments/ Instructions:
•
O
PASS ❑ PARTIAL APPROVAL I I CANCEL NO ACCESS
n FAIL CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
}
, Inspector: Date: ( 7 / 7Phone #: (503) 718-